Oral Medication Stops Prolonged Epileptic Seizures
By Joan Unger, RN, MS, ARNP-C
Convulsive status epilepticus is the most common neurologic medical emergency and often results in high morbidity or death. Effective treatment that can be safely administered before hospital admission is vital, and prolonged seizures lasting five minutes or more are commonly treated with injectable or rectal medications. This study compared rectally administered diazepam with orally administered midazolam.
Students (42) ranging in age from 5-18 with severe epilepsy were recruited from a residential school with on-site medical facilities. Midazolam was applied around the child’s buccal mucosa. If the seizure did not stop within 10 minutes, additional medication of the attending’s choice was administered. Patients’ oxygen saturation and blood pressure were monitored for 30 minutes following treatment. Outcomes measures included efficacy, time from arrival of the nurse until the drug was administered, time from drug administration to end of seizure, and the incidence of adverse cardiorespiratory events.
Fourteen students received buccal midazolam to treat 40 seizures, and 14 received rectal diazepam for 39 seizures. The midazolam effectively stopped 75% (30) of the 40 seizures. Diazepam stopped only 59% (23) of 39 seizures. Time frames for the nurse’s arrival, drug administration, and end of seizure were similar for both groups. There were no important adverse cardiorespiratory events. Investigators conclude that buccal midazolam is at least as effective as rectal diazepam, more socially acceptable and convenient, and may become the drug of choice for extended seizures occurring outside the hospital.
Source
Scott R. Buccal midazolam and rectal diazepam for treatment of prolonged seizures in childhood and adolescence: A randomized trial. Lancet 1999;353:623-626.
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